Medicaid Backlog Affecting Practices Ability to Care for Patients

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According to a recent report from RollCall.com, almost half of the 6 million new Medicaid coverage enrollments have not yet been processed. State agencies have been blaming the delay on technology issues between the federal website and state websites, combined with the high volume of enrollees. After realizing the difficulties associated with applying online, many states have begun to encourage people to enroll for Medicaid in person and through other methods.

Unfortunately for physicians, they could be held responsible for any services incurred before the patient is verified. There’s always a chance that unverified Medicaid patients could be ineligible for coverage, and therefore, the physician will have to treat the patient as uninsured.

Primary care physicians already have other complaints about Medicaid. One such complaint is that the program pays up to two-thirds less than Medicare. As a solution, the Affordable Care Act (ACA) has included funding for increased Medicaid payments for certain primary care services to match Medicare payments until the end of 2014. The AAFP states that the increase in reimbursement should be extended. Although the payment adjustment began in 2013, there are many states that haven’t yet increased their payments to medical practices.

Most practices cannot risk turning away potential Medicaid patients. However, they still have financial obligations. 65 million people currently receive health insurance through Medicaid, as reported by federal data. According to a study from the Journal of the American Medical Association (JAMA), only 58% of Medicaid patients were able to make an appointment with a primary care physician during the time period included in the study, compared with 85% of patients who had private insurance and 79% of patients who paid with cash.

Author: Lauren Daniels